Individual
SUSAN V. BASTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
546 E CHIPETA WAY STE 220, SALT LAKE CITY, UT 84108-1221
(801) 581-7172
Mailing address
PO BOX 413034, SALT LAKE CITY, UT 84141-3034
(801) 213-3900
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
212263-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130024988
RAILROAD MEDICARE
UT
Enumeration date
10/13/2006
Last updated
10/21/2021
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